Chiou Daniel, Mooney Bailey, Jensen Andrew R
Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA.
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
JSES Int. 2024 Nov 14;9(2):562-567. doi: 10.1016/j.jseint.2024.10.008. eCollection 2025 Mar.
Atraumatic avascular necrosis (AVN) of the elbow is a rare diagnosis with little literature describing features of this pathology. The purpose of this study is to investigate atraumatic elbow AVN in adults, with a focus on the anatomic distribution of AVN within skeletally mature elbows.
A retrospective chart review was conducted on six patients who were identified via term searches of elbow magnetic resonance imaging (MRI) done at the authors' institution that also had appropriate diagnoses. Terms included "necrosis", "AVN", and "avascular". Demographic data were collected, including age of diagnosis, sex, associated comorbidities, use of steroids, use of chemotherapeutic agents, alcohol consumption, smoking status, and associated joint involvement. Clinical information regarding presentation and treatment course were also gathered. Both plain film and MRI were evaluated for identification of anatomic involvement of disease and staging.
Six patients were included in the study: three men and three women with a mean age of 26.5 years (17-46) at time of diagnosis. All patients presented with elbow pain and one patient presented additionally with loss of full range of motion. Four of the six patients had a prior cancer diagnosis (T-cell acute lymphoblastic leukemia x2, follicular lymphoma, acute myeloblastic leukemia) that led to chemotherapy exposure, and two of them had additional steroid therapy. Another two had autoimmune diseases (systemic lupus erythematous and dermatomyositis) that required high dose steroid therapy. At time of initial imaging, the capitellum was involved in 8 of 9 elbows, the trochlea in 8 of 9 elbows, the radial head in 4 of 9 elbows, the proximal ulna in 2 of 9 elbows, and the olecranon in 1 of 9 elbows. Only one elbow had additional sites of the elbow affected at future follow-ups. One patient presented with AVN of the capitellum, trochlea, and ulnar neck, and two years later had signs of olecranon osteonecrosis on MRI. Two patients underwent operative treatment with resolution of symptoms.
This study describes the anatomic incidence of AVN of the elbow. Most involved are the capitellum and trochlea, with involvement in the radial head, proximal ulna, and olecranon also being observed. This information can be used to help orthopedic surgeons in their diagnosis and clinical decision making for affected patients.
肘部创伤性无血管性坏死（AVN）是一种罕见的诊断，几乎没有文献描述这种病理特征。本研究的目的是调查成人创伤性肘部AVN，重点关注骨骼成熟肘部AVN的解剖分布。
对通过在作者所在机构进行的肘部磁共振成像（MRI）术语搜索确定的6例患者进行回顾性病历审查，这些患者也有适当的诊断。术语包括“坏死”“AVN”和“无血管”。收集人口统计学数据，包括诊断年龄、性别、相关合并症、类固醇使用情况、化疗药物使用情况、饮酒情况、吸烟状况以及相关关节受累情况。还收集了有关临床表现和治疗过程的临床信息。对X线平片和MRI进行评估，以确定疾病的解剖受累情况和分期。
6例患者纳入研究：3例男性和3例女性，诊断时平均年龄26.5岁（17 - 46岁）。所有患者均出现肘部疼痛，1例患者还出现了活动范围受限。6例患者中有4例曾有癌症诊断（2例T细胞急性淋巴细胞白血病、滤泡性淋巴瘤、急性髓细胞白血病）并接受过化疗，其中2例还接受了额外的类固醇治疗。另外2例患有自身免疫性疾病（系统性红斑狼疮和皮肌炎），需要高剂量类固醇治疗。在初次成像时，9个肘部中有8个的肱骨小头受累，9个肘部中有8个的滑车受累，9个肘部中有4个的桡骨头受累，9个肘部中有2个的尺骨近端受累，9个肘部中有1个的鹰嘴受累。只有1个肘部在未来随访中有肘部其他部位受累。1例患者出现肱骨小头、滑车和尺骨颈AVN，两年后MRI显示鹰嘴有骨坏死迹象。2例患者接受手术治疗后症状缓解。
本研究描述了肘部AVN的解剖发生率。受累最多的是肱骨小头和滑车，也观察到桡骨头、尺骨近端和鹰嘴受累。这些信息可用于帮助骨科医生对受影响患者进行诊断和临床决策。
